Provider Demographics
NPI:1407418262
Name:MALENFANT, CARLYN JEAN (DMD)
Entity Type:Individual
Prefix:
First Name:CARLYN
Middle Name:JEAN
Last Name:MALENFANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3008
Mailing Address - Country:US
Mailing Address - Phone:513-272-2792
Mailing Address - Fax:980-444-9196
Practice Address - Street 1:6911 MAIN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3008
Practice Address - Country:US
Practice Address - Phone:513-272-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0263431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11501OtherPRIVATE INS